Allergen-specific immunotherapy（AIT） remains the only therapeutic approach with the potential to modify the natural course of allergic rhinitis（AR）. Nevertheless, considerable inter-individual variability exists in patients'responses to AIT. To facilitate more reliable assessment of treatment efficacy, the China Rhinopathy Research Cooperation Group（CRRCG） convened young and middle-aged nasal experts in China to formulate the present consensus. The recommended subjective outcome measures for AIT comprise symptom scores, medication scores, combined symptom and medication scores, quality-of-life assessments, evaluation of disease control, and assessment of comorbidities. Objective indicators may supplement these measures. Currently available objective approaches include skin prick testing, nasal provocation testing, and allergen exposure chambers. However, these methods remain constrained by practical limitations and are not yet appropriate for routine implementation in clinical efficacy evaluation. In addition, several biomarkers, including sIgE and the sIgE/tIgE ratio, sIgG4, serum IgE-blocking activity, IgA, cytokines and chemokines, as well as immune cell surface molecules and their functional activity, have been shown to have associations with AIT outcomes. While these biomarkers may complement subjective assessments, they are subject to significant limitations. Consequently, large-scale multicenter trials and real-world evidence are required to strengthen the evidence base. The present consensus underscores the necessity of integrating patients'subjective experiences with objective testing throughout the treatment process, thereby providing a more comprehensive and accurate framework for efficacy evaluation. Looking forward, future investigations should prioritize the incorporation of multi-omics data and artificial intelligence methodologies, which hold promise for overcoming current limitations in assessment strategies and for advancing both the standardization and personalization of AIT.
Humans ; Allergens/immunology* ; China ; Consensus ; Desensitization, Immunologic ; Immunoglobulin E ; Quality of Life ; Rhinitis, Allergic/therapy* ; Treatment Outcome ; East Asian People

OBJECTIVE To investigate the use of common disposable and reusable supplies for prevention and con-trol of infections in Shanghai.METHODS A survey was conducted for the use and reuse of disposable high-value consumables,disposable bronchoscopes and environmental cleaning and disinfection tools in Shanghai by using structured questionnaire.RESULTS Totally 81 medical institutions were involved in the survey,44(54.32％)of which were tertiary hospitals,and the median number of beds was 500.The orthopedic implants(70.37％),ul-trasound knife(69.14％)and endoscopic puncture instrument(66.67％)were the high-value consumables rank-ing the top 3 utilization rates.There was reuse of 18 types of high-value consumables in total among the 12 medi-cal institutions.The major causes of reuse of high-value consumables included fee less tan cost of consumables(58.33％)or being unable to included in charge items(33.33％).27.78％of the recycle high-value consumables were not treated with a dedicated disinfection and sterilization system and procedures for the disposable high-value consumables,and 33.33％did not have the report systems for related adverse reactions.49.09％of the medi-cal institutions reported to use the disposable bronchoscopes,4 of which reused them.The majority of the medi-cal institutions could carry out centralized cleaning and disinfection for the recycled floor cloths(60.81％)and cloth towels(56.76％),and 32.43％of the medical institutions reused the cloth towels by manual cleaning.The utilization rate of antiseptic wipes was 75.41％in adult intensive care unit,62.50％in neonatal intensive care unit.CONCLUSION The study reveals that there are some problems in the use of disposal and reusable supplies for prevention and control of infections,which may provide baseline data for management of the related supplies and the surveillance of disinfection of the recycled supplies so as to enhance the quality of management of hospital-asso-ciated infections.

Objective:To evaluate the safety and efficacy of using small and ultra-small sized grafts for in situ auxiliary liver transplantation in the treatment of portal hypertension.Methods:A prospective single-arm cohort study was conducted. Patients who underwent liver transplantation at Beijing Friendship Hospital from December 2014 to July 2025 were included. Intraoperative portal vein pressure was routinely monitored, with the target regulation for portal vein blood flow set at<15 mmHg (1 mmHg=0.133 kPa) and follow-up continued until September 2025. The primary endpoints were the patient's status and graft survival. The secondary endpoints were small-for-size syndrome and perioperative complications. The small-for-size syndrome was graded according to the 2023 International Liver Transplantation Society consensus statement.Results:A total of 33 cases were enrolled. Among them, 22 had ultra-small size grafts, 11 had small-size grafts, 28 had living donor grafts, and five had split grafts. The graft-to-recipient weight ratio in living donor liver transplantation was 0.31%～0.79%, while in split liver transplantation it was 0.45%～1.02%. Intraoperative portal vein pressure of ≥15 mmHg was observed in 11 cases, who underwent portal vein blood flow adjustment via splenic artery ligation (2 cases), partial splenectomy (8 cases), and/or restrictive portocaval shunting (1 case), after which all patients achieved the target portal vein pressure. All cases completed at least one month of follow-up, with 28 cases following for more than one year, and the median follow-up period was 36.5 months. Early-stage postoperative small-for-size syndrome occurred in eight cases (24.2%, 8/33), all classified as grade A, with improvements following supportive treatment. Severe complications (Clavien-Dindo≥Ⅲ) occurred in three cases (9.1%, 3/33). The one-year survival rate was 92.9% (26/28). The overall survival rate at the end of follow-up was 90.9% (30/33). No patients experienced graft loss or death due to small-for-size syndrome. Graft tissue tested negative for hepatitis B core antibody and covalently closed circular DNA, and hepatitis B surface antigen seroconversion was achieved following second-stage residual liver resection and under a combined strategy of potent nucleos(t)ide analogs and hepatitis B immunoglobulin in ten cases of hepatitis B-related disease.Conclusions:With standardized portal vein blood flow monitoring and individualized portal vein blood flow adjustment, in situ auxiliary liver transplantation can safely and effectively use small and even ultra-small sized grafts, thereby significantly expanding graft sources and ensuring donor and recipient safety. These findings warrant further validation and promotion in multicenter controlled studies.

Objective To analyze the diversity and composition of gut microbiota in individuals with circadian rhythm disruption and their correlation with cognition.Methods Night shift workers and regular shift workers were subjected from our hospital during August 2022 and October 2024.The participants with circadian rhythm disorders were assigned into an experimental group(n=24),and those with normal circadian rhythms were into a control group(n=24).Their height,weight,age,gender,body mass index(BMI)and fresh fecal samples were collected,and Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)were used to evaluate their mental status.Metagenomics,Alpha and Beta diversity analyses,Linear Discriminant Analysis Effect Size(LEfSe),and Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis were employed to investigate the diversity and function characteristics of gut microbiota in the participants.Results There were no statistical differences between the 2 groups in baseline data,such as height,weight,gender,age,and BMI(P>0.05).Alpha diversity analysis indicated that no statistical differences were observed in the ACE,Chao1,Shannon,or Simpson indices between the 2 groups,while beta diversity analysis revealed significant differences(P<0.01),suggesting different structure of gut microbiota between them.In the experimental group,the abundance of Faecalibacterium prausnitzii and Agathobacter rectalis was decreased,while that of Escherichia coli and Phocaeicola vulgaratus was increased,with significant differences when compared with the control group(P<0.05).Additionally,KEGG functional analysis showed that the experimental group had obviously higher expression levels in Th17 cell differentiation and the IL-17 signaling pathway than the control group(P<0.05).Agathobacter rectalis and Faecalibacterium prausnitzii were positively correlated with MoCA score and MMSE score(P<0.05,P<0.01).Agathobacter rectalis was negatively correlated with the IL-17 signaling pathway and Th17 cell differentiation.Conclusion Individuals with circadian rhythm disorders have significant changes in the structure and function of gut microbiota when compared to those with normal circadian rhythms.Agathobacter rectalis may be involved in the regulation of the IL-17 signaling pathway and differentiation of Th17 cells,thereby possibly impacting the increases of cognitive score related to circadian rhythm disorders.

In recent years, studies have demonstrated that exosomes can replace mesenchymal stem cell for chronic wound repair. However, exosomes have some problems such as poor targeting, low availability and low yield, which collectively limit their therapeutic efficacy in chronic wound treatment. Maximizing the therapeutic benefits of exosomes is the primary challenge that needs to be overcome when used for chronic wound repair. Studies have shown that the treatment potential of exosomes can be further developed by pretreatment and engineering modification of exosomes. This article reviewed the research progress of exosome pretreatment and engineering modification in chronic wound repair, and provided reference for subsequent research and clinical application.

Objective To construct and validate machine learning-based models to predict the risk of acute kidney injury(AKI)following percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 2 315 STEMI patients who underwent PCI between January 2020 and June 2023 were included;306(13.2％)of them developed AKI.Baseline variables were screened using LASSO regression,with the optimal λ value selected via 10-fold cross-validation to identify AKI-associated features.Subsequently,eight distinct machine learning models were constructed and evaluated for their predictive performance.SHAP value analysis was employed to assess the impact of key variables on model predictions.Results LASSO regression identified seven variables significantly associated with AKI,including age,multivessel disease,preoperative creatinine,heart failure,white blood cell count,hemoglobin,and albumin levels.Among all the models,the light gradient boosting machine(LGBM)and extreme gradient boosting(XGB)demonstrated the best predictive performance,with training set AUCs being 0.899(95％CI:0.877-0.921)and 0.893(95％CI:0.868-0.918),and validation set AUCs being 0.809(95％CI:0.763-0.856)and 0.871(95％CI:0.833-0.909),respectively.SHAP analysis revealed that albumin,age,preoperative creatinine,and white blood cell count were the primary contributors to AKI risk.Conclusion This study successfully developed and validated machine learning-based predictive models capable of effectively identifying the risk of AKI following PCI in STEMI patients,thus providing valuable support for clinical decision-making.

Objective:To investigate analgesic effect of fire needle on postherpetic neuralgia(PHN)rats and its effect on IL-10/β-endorphin(β-EP)signaling pathway.Methods:Forty rats were randomly divided into 4 groups:control group,model group,fire needle group and drug group,with 10 rats in each group.PHN model was constructed by intraperitoneal injection of resin toxin.Af-ter successful modeling,fire needle group was intervened by fire needle at L4～6 Jiaji points,and drug group was intervened by intra-peritoneal injection of gabapentin.Von Frey electronic pain meter was used to measure paw withdrawal mechanical threshold(PW-MT)of rats in each group.Thermal latency of paw withdrawal(PWTL)of rats was measured by thermal radiation stimulator.Prosta-glandin E2(PGE2)and substance P(SP)in dorsal root ganglion tissues,serum IL-6,TNF-α and IL-1β levels were detected by ELI-SA.IL-10 and β-EP protein expressions in spinal cord of rats were detected by Western blot.Results:Compared with control group,PWMT of model group was decreased significantly(P<0.05),PWTL,levels of PGE2 and SP in spinal cord tissue and levels of IL-6,TNF-α and IL-1β in serum were increased significantly(P<0.05),IL-10 and β-EP protein expressions in spinal dorsal horn were decreased significantly(P<0.05).Compared with model group,PWMT of fire needle group and drug group was significantly increased(P<0.05),PWTL,PGE2 and SP in spinal cord tissue and serum IL-6,TNF-α and IL-1β levels were significantly decreased(P<0.05),IL-10 and β-EP protein expressions in spinal dorsal horn were significantly increased(P<0.05).Conclusion:Fire needle can improve pain response of PHN rats and reduce peripheral blood inflammation level,which may be related to activation of IL-10/β-EP signaling pathway.

BACKGROUND:The regulatory mechanisms of acupotomy intervention for knee osteoarthritis at a transcriptome level are not well understood despite its proven clinical efficacy.OBJECTIVE:Using acupotomy therapy in a rat model of knee osteoarthritis,to conduct transcriptome sequencing and bioinformatics analysis on cartilage samples,along with validation,and to reveal the molecular regulatory mechanisms involved in this therapy for knee osteoarthritis in rats.METHODS:Forty-eight Sprague-Dawley rats were selected and divided into three groups by random number table method,acupotomy group,model group,and sham operation group,with 16 rats in each group.Osteoarthritis models were induced by medial meniscus instability in the acupotomy group and model group.After successful modeling,acupotomy group rats were treated with acupotomy once a week,for 4 weeks in total.After the intervention,cartilage samples from the rat's knee joint were stained with hematoxylin-eosin staining and safranin O-fast green staining,evaluated by Mankin scores,and underwent MicroCT scanning.Serum inflammatory factor levels were detected by Elisa.Transcriptome sequencing was performed on the remaining cartilage samples,and the data were analyzed using R software to identify differential gene expression levels among the groups.Core targets were screened through protein-protein interaction network and Cytoscape and validated using RT-qPCR.RESULTS AND CONCLUSION:Compared with the sham operation group,rats in the model group had rough and uneven articular cartilage surfaces,narrowed joint spaces,destroyed articular surface structures,elevated Mankin scores,and significant increases in serum levels of interleukin-6,tumor necrosis factor-α,and matrix metalloproteinase 13(P<0.05).Compared with the model group,rats in the acupotomy group had smoother articular cartilage surfaces,wider joint spaces,slightly irregular articular surfaces,lower Mankin scores,and significantly lower serum levels of interleukin-6,tumor necrosis factor-α,and matrix metalloproteinase-13(P<0.05).Gene ontology and Kyoto genome and genome encyclopedia analyses involved proteolytic metabolism,autophagy,mitogen-activated protein kinase,nuclear factor kB,and Wnt signaling pathways.Protein-protein interaction network and Cytoscape screened for four key genes,including ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor.The mRNA expression of ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor in the articular cartilage of rats in the model group was lower than that of the sham operation group(P<0.05),while the mRNA expression of ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor in the articular cartilage of rats in the acupotomy group was higher than that in the model group(P<0.05).To conclude,acupotomy treatment of knee osteoarthritis in rats may act on signaling pathways such as MAPK,nuclear factor kB,and Wnt to promote cartilage repair,and is closely related to the expression of genes associated with ataxia-telangiectasia mutations,Myb SWIRM and MPN domain protein 1,heat shock protein 90α1,and NIPBL cohesion-loading factor.

Objective To construct and validate machine learning-based models to predict the risk of acute kidney injury(AKI)following percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 2 315 STEMI patients who underwent PCI between January 2020 and June 2023 were included;306(13.2％)of them developed AKI.Baseline variables were screened using LASSO regression,with the optimal λ value selected via 10-fold cross-validation to identify AKI-associated features.Subsequently,eight distinct machine learning models were constructed and evaluated for their predictive performance.SHAP value analysis was employed to assess the impact of key variables on model predictions.Results LASSO regression identified seven variables significantly associated with AKI,including age,multivessel disease,preoperative creatinine,heart failure,white blood cell count,hemoglobin,and albumin levels.Among all the models,the light gradient boosting machine(LGBM)and extreme gradient boosting(XGB)demonstrated the best predictive performance,with training set AUCs being 0.899(95％CI:0.877-0.921)and 0.893(95％CI:0.868-0.918),and validation set AUCs being 0.809(95％CI:0.763-0.856)and 0.871(95％CI:0.833-0.909),respectively.SHAP analysis revealed that albumin,age,preoperative creatinine,and white blood cell count were the primary contributors to AKI risk.Conclusion This study successfully developed and validated machine learning-based predictive models capable of effectively identifying the risk of AKI following PCI in STEMI patients,thus providing valuable support for clinical decision-making.